[Telemedicine: a Proxemics tool of Primary Care?] / La telemedicina: uno strumento di prossemica dell'assistenza territoriale?

The impact of demographic and sociopolitical phenomena such as population aging, economic and social changes derivinf from globalization and the pervasiveness of information technologies, require innovative and efficient responses to new health needs, characterized by the increase o in the numer of healthcare procedures and its complexity. The COVID 19 has had a negative impact on the that context. This paper demonstrates that the telemdicine enables to optimize resources, as well as to ensure the distancing and delivery times of services. The telemedicine in the time of COVID is the new proxemics tool of Primary care.

Antithrombin III metabolism in the pulmonary vessel endothelium.

In 85 patients undergoing aorto-coronary bypass for atherosclerotic coronary disease, we measured the antithrombin III activity levels and the thrombin-antithrombin III complex concentrations in blood from the pulmonary and the radial arteries, taken before the aorto-coronary bypass procedure, with the aim of investigating the role of the pulmonary endothelium in the metabolism of the inhibitor. Results showed significantly lower mean antithrombin III activity levels, expressed as a percentage of normal plasma, in blood from the radial artery with respect to levels from the pulmonary artery (0.78 +/- 0.12 versus 0.80 +/- 0.12, P<0.0001), while no significant difference was found in thrombin-antithrombin III complex concentrations. The results seem to show that the pulmonary endothelium contributes to the antithrombin III metabolism with a 0.023 breakdown rate, corresponding to about a 0.1 fraction of the reported 0.22-0.25 total body catabolic rate, as well as the pulmonary endothelial surface (50-70 m2) corresponding to about a 0.1 fraction of the peripheral vessels' endothelial surface (500-700 m2). The data support the hypothesis of a main endothelial catabolism of antithrombin III.

Fibrinogen metabolism in the lungs.

The aim of this study was to evaluate the role of the pulmonary vessel endothelium in the metabolism of fibrinogen (FBG), by measuring the FBG, D-dimer, and fibrin(ogen) degradation product levels in the blood from pulmonary and radial arteries from 99 patients undergoing aortocoronary bypass. For comparison, protein C, protein S, and factor VII, were also measured. The results showed, with respect to the pulmonary arterial blood levels, significantly lower FBG levels (3.72 +/- 0.83 vs 3.66 +/- 0.81 g/L; P < .001) and higher fibrin(ogen) degradation product levels (7.36 +/- 1.53 vs 8.15 +/- 1.59 mg/L; P < .000 01) in the radial arterial blood. No difference was found for d -dimer, protein C, protein S, and factor VII. The study demonstrated that the pulmonary capillary endothelium contributes to the FBG catabolism for about a 0.02 fractional rate and support the view of an endothelial FBG catabolic pathway as the main catabolic pathway, owing to the fact that the pulmonary endothelial surface is about a 0.1 fraction of the peripheral vessel endothelial surface.

Alfentanil and sufentanil in fast-track anesthesia for coronary artery bypass graft surgery.

OBJECTIVE: To evaluate alfentanil, sufentanil, and the combination of both opioids in patients undergoing cardiac surgery. DESIGN: Prospective, randomized study. SETTING: University hospital. PARTICIPANTS: Patients undergoing coronary artery bypass graft (CABG) surgery (n = 195), randomly assigned to 3 groups of 65 each. INTERVENTIONS: Patients in group A received alfentanil, induction (15 microg/kg) and maintenance (15 microg/kg/hr); patients in group S received sufentanil, induction (1 microg/kg) and maintenance (1 microg/kg/h); and patients in group AS received alfentanil and sufentanil, induction with alfentanil (15 microg/kg) and maintenance with sufentanil (1 microg/kg/hr). MEASUREMENTS AND MAIN RESULTS: Hemodynamic data showed a reduction of all parameters at induction in the 3 groups (p < 0.05). Cardiac index decreased at induction in all groups (p < 0.05) but increased in groups S and AS toward baseline values at the end of surgery. The intubation time and length of stay in the intensive care unit were less in group AS (2.3 +/- 1.2 hours; p < 0.001 and 20 +/- 8 hours; p < 0.05), than in groups A (4.2 +/- 1.7 hours and 28 +/- 13 hours) and S (3.1 +/- 1.1 hours; p < 0.05 and 26 +/- 12 hours). Length of hospital stay and patients' outcome were similar in the 3 groups. CONCLUSION: Although the differences among groups regarding extubation time, intensive care unit length of stay, and some hemodynamic data were statistically significant, the differences were clinically small. All 3 anesthetic protocols were shown to be safe and appropriate for patients undergoing elective coronary artery bypass graft surgery and early postoperative tracheal extubation.